Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation

Gouvêa, Glauber; Díaz, Rodrigo; Auler, L.; Toledo, Renato; Martinho, José Manoel

doi:10.1093/bja/aep123

Cited by 47 publications

(31 citation statements)

References 29 publications

(15 reference statements)

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“…Dynamic indices had better AUROC and correlation than static measures across studies. Furthermore, in addition to [12] Prospective observational study 2b 13 Feissel et al 2005 [13] Prospective observational study 2b 15 Natalini st al 2006 [14] Prospective observational study 2b 16 Solus-Biguenet et al 2006 [15] Prospective observational study 2b 15 Cannesson et al 2006 [16] Prospective observational study 2b 15 Lamia et al 2007 [17] Prospective observational study 2b 14 Soubrier et al 2007 [18] Prospective observational study 2b 15 Belloni et al 2008 [19] Prospective observational study 2b 16 Cannesson et al 2008 [20] Prospective observational study 2b 15 Auler et al 2008 [21] Prospective observational study 2b 14 Huang et al 2008 [22] Prospective observational study 2b 13 Biais et al 2008 [23] Prospective observational study 2b 13 Keller et al 2008 [24] Prospective observational study 2b 12 Mutoh et al 2009 [25] Randomised non-blinded study 2b 13 Ranucci et al 2009 [26] Prospective observational study 2b 15 Gouvea et al 2009 [27] Prospective observational study 2b 15 Cannesson et al 2009 [28] Prospective observational study 2b 15 Biais et al 2009 [29] Prospective observational study 2b 15 Skulec et al 2009 [30] Randomised blinded study 2b 16 Preau et al 2010 [31] Prospective observational study 2b 15 Delerme et al 2010 [32] Prospective observational study 2b 15 Desgranges et al 2011 [33] Prospective observational study 2b 14 Guinot et al 2011 [34] Prospective observational study 2b 15 Muller et al 2011 [35] Prospective observational study 2b 14 Muller et al 2012 [36] Prospective observational study 2b 15 de Oliveira-Costa et al 2012 [37] Cross-sectional observational study 2b 14 Feissel et al 2013 [38] Prospective observational study 2b 14 Brun et al 2013 [39] Prospective observational study 2b 15 Chin et al 2013 [40] Prospective observational study 2b 15 Wu et al 2014 …”

Section: Discussionmentioning

confidence: 99%

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

et al. 2015

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SummaryAccurate assessment of intravascular fluid status and measurement of fluid responsiveness have become increasingly important in peri-operative medicine and critical care. The objectives of this systematic review and narrative synthesis were to discuss current controversies surrounding fluid responsiveness and describe the merits and limitations of the major cardiac output monitors in clinical use today in terms of usefulness in measuring fluid responsiveness. We searched the MEDLINE and EMBASE databases (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015); inclusion criteria included comparison with an established reference standard such as pulmonary artery catheter, transthoracic echocardiography and transoesophageal echocardiography. Examples of clinical measures include static (such as central venous pressure) and dynamic (such as stroke volume variation and pulse pressure variation) parameters. The static parameters measured were described as having little value; however, the dynamic parameters were shown to be good physiological determinants of fluid responsiveness. Due to heterogeneity of the methods and patient characteristics, we did not perform a meta-analysis. In most studies, precision and limits of agreement (bias AE1.96SD) between determinants of fluid responsiveness measured by different devices were not evaluated, and the definition of fluid responsiveness varied across studies. Future research should focus on the physiological principles that underlie the measurement of fluid responsiveness and the effect of different volume expansion strategies on outcomes.

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Section: Discussionmentioning

confidence: 99%

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

et al. 2015

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“…50,51 Finally, unless dynamic monitors provide an accurate assessment of cardiac output, they are poor at distinguishing absolute hypovolemia from apparent hypovolemia due to a low systemic vascular resistance. 52 Again, it is vital to assess volume responsiveness within the overall context of the patient and the likelihood that a volume deficit is present.…”

Section: Maintenance Fluid Therapymentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

137

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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“…PPV has been validated and used to guide fluid therapy in a variety of surgical patients, which include those undergoing major abdominal procedures [39], liver transplantation [40], cardiac surgery [15,41-43] and scoliosis surgery [44]. Additionally, a high PPV value was associated with higher inflammatory response and lower organ yield in brain-dead organ donors [45].…”

Section: Pulse Pressure Variationmentioning

confidence: 99%

Bench-to-bedside review: Functional hemodynamics during surgery - should it be used for all high-risk cases?

2013

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The administration of a fluid bolus is done frequently in the perioperative period to increase the cardiac output. Yet fluid loading fails to increase the cardiac output in more than 50% of critically ill and surgical patients. The assessment of fluid responsiveness (the slope of the left ventricular function curve) prior to fluid administration may thus not only help in detecting patients in need of fluids but may also prevent unnecessary and harmful fluid overload. Unfortunately, commonly used hemodynamic parameters, including the cardiac output itself, are poor predictors of fluid responsiveness, which is best assessed by functional hemodynamic parameters. These dynamic parameters reflect the response of cardiac output to a preload-modifying maneuver (for example, a mechanical breath or passive leg-raising), thus providing information about fluid responsiveness without the actual administration of fluids. All dynamic parameters, which include the respiratory variations in systolic blood pressure, pulse pressure, stroke volume and plethysmographic waveform, have been repeatedly shown to be superior to commonly used static preload parameters in predicting the response to fluid loading. Within their respective limitations, functional hemodynamic parameters should be used to guide fluid therapy as part of or independently of goal-directed therapy strategies in the perioperative period.

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Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation

Abstract: Under the conditions of this study, the PPV index was not shown to be a reliable predictor of FR during OLT. Further studies are warranted to elucidate the role of this and other dynamic indexes in this specific setting.

Cited by 47 publications

References 29 publications

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Bench-to-bedside review: Functional hemodynamics during surgery - should it be used for all high-risk cases?

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